Imperfect practice: A tool for developing professional skills in Child and Youth Care

Frank Ainsworth

This article uses an incident of imperfect practice in a residentially based programme for adolescents to show how such events can be used to improve professional skills. The programme is a learning and living environment designed to re-educate and re-socialise conceptually able conflicted acting out adolescents. It caters for both male and female adolescents between the ages of 14 and 17 years who generally are statutory clients of the state department and who may be the subject of court orders. A particular feature of the programme is it’s focus on the restoration of parental authority (Munichin 1974, Bruggen, 1975) and on improving the quality of the relationship between the adolescent and his natural family.

A description of the incident, which is controversial in its own right because it involved the physical restraint of an adolescent, is followed by a critical analysis of the incident (Beker, 1972). The analysis focuses on alternative interventions for practitioners faced with such events together with comment on these alternatives. Following this section of the article a draft practice guideline is offered. The value of agencies having such guidelines is then discussed with emphasis being placed on the added security that this provides for practitioners. A concluding section elaborates further on the value of critical incident analysis as a tool that ensures accountability, openness and the maintenance of high quality practice especially with child and adolescent populations that can be very demanding of adult practitioners.

The incident
During the course of a Friday afternoon a plan was hatched by two residents of the house, Felicity and Sarah, to ambush (their word) Peter, another resident, on his way back to the house from work and to soak him with water. This plan had its origin in earlier water fights which had occurred in and out of the house over the preceding ten days and which had been the subject of attention by all practitioners.

On hearing of this plan indirectly, one of the practitioners working in the house, John, decided that he would discreetly stow away all buckets which might be used for such a venture and remove the hosepipe from the garden tap at the front of the house as a further precautionary measure.

Shortly before 7 pm Felicity and Sarah openly announced their intentions and John immediately intervened and told them that this action was silly and that they were forbidden to use any house property to assist with their plan. This was to prevent them using household items as water containers. John was challenged about this by both girls and Felicity adopted the position that the matter had nothing to do with the house as all the action was to take place outside the premises. This John repudiated given that all involved were residents of the house and because the ambush was scheduled to take place in the immediate vicinity of the house and in full view of neighbours. Nevertheless, both residents proceeded to acquire from a resident’s bedroom, which they did not have permission to enter, a privately owned plastic bucket. They also acquired from their own bedrooms plastic shopping bags to be used as water bombs. After this they left the house in spite of further pleas to them to abandon the whole scheme. On leaving the house they chose to lock the front entrance by turning the locking button on the inside door handle. This action came to John's notice because in their by now highly emotional state the girls talked and giggled loudly about their intentions. They planned to lock the door so that the returning resident Peter would be cornered outside the house and be unable to enter and escape from their water throwing activity. As soon as Felicity and Sarah had departed John released the locking button on the front door so that Peter might gain access to the house.

At this point John returned to the lounge area and sat with Maria, another practitioner, and two female residents who were not involved in this behaviour but who had witnessed the entire sequence of events. Before very long the calm of the lounge area was shattered by the arrival of a noisy over excited Felicity who rushed to her bedroom and emerged with an empty waste bin that she clearly intended to use as a water container. John, who was carefully monitoring developments, confronted her about this in the corridor outside her bedroom and told her that as the bin was house property she could not take it outside the premises. Surprisingly, she responded to this instruction and returned the bin to her room. After this she walked hurriedly across the lounge area to the front door. She was followed by John who asked her to cease indulging in this juvenile and delinquent behaviour. This plea was ignored.

John again sat down with the others in the lounge only to find the calm of that area again quickly shattered by the arrival of a wet and dishevelled Peter and shortly thereafter Felicity and Sarah. Felicity and Sarah were screaming and waving water filled plastic bags. They proceeded to chase Peter to his bedroom. Shortly afterwards John went to this area to find all three engaged in bucket and plastic bag water filling activities. In spite of pleas to stop these activities water was thrown in two bedrooms. John insisted that they all return to the lounge area to which all three residents raced amidst screams. By the time John arrived in that area Felicity and Sarah were jumping up and down screaming and waving over their heads plastic bags containing water. By now Felicity and Sarah were out of control. John intervened and physically pushed Sarah towards the bedroom corridor in order to remove her from the scene. Once she was moving in that direction John returned to the lounge where he quickly opened a patio door. John physically picked up Felicity and forcefully placed her on the patio locking the door in order to leave her outside the lounge area. However, by this time Sarah had returned to the lounge and she unlocked the patio door allowing Felicity to re-enter the lounge. Still in a very high emotional state both girls proceeded to leave the house by way of the front entrance. Once they left the house John locked the front door.

John returned to the lounge and sat with Maria and the two other residents all of whom had witnessed all of the above events. By this time Peter had retired to his bedroom. A long discussion took place between the residents and the practitioners about the incident and especially the physical intervention. Not surprisingly no one was pleased with the course of events. However, all agreed that the out of control behaviour had to be stopped and that the intervention had resulted in calm returning to the house. Some twenty minutes later at about 7.50 pm both Felicity and Sarah came to the front door and rang the bell to achieve entry. John answered the door and asked them for a commitment, prior to entry, to a cessation of the previous behaviour. This commitment was given by Sarah but not by Felicity who merely pushed her way into the house saying that this was where she lived. When John pointed out to her that she had not made a commitment as Sarah had done she simply replied that she knew that. However, from this point on there was no return to the screaming, hysterical, out of control behaviour that had been a feature of the house for the preceding hour. Later that night Sarah apologised to John for her behaviour earlier in the evening. Felicity left the house to go out with a male friend returning by 10.30pm, at which point she went straight to bed.

Incident analysis and alternative interventions
From this description of a practice incident which led to two adolescents being physically restrained many questions emerge as to the appropriateness of the interventions. Some alternative interventions are now canvassed with each receiving comment.

Alternative 1: The practitioner could simply have regarded this incident as the adolescents would later claim as “just good fun”. That possibility is worthy of consideration in that it argues that the practitioners involved should have adopted a stance of minimal intervention in the belief that by doing so the incident would run its own course and come to an end without any harm to either those involved or the programme.

Comment: The explanation “it was just good fun and if you had left us alone everything would have been alright” is one that is often heard. What has to be remembered here is that such a comment is designed to shift responsibility from the adolescents involved in the incident onto the practitioners. In essence the adolescents are saying if only your practice was better then we would not have been involved in such an incident. Indeed practitioner responses may be less than ideal but attempts of this type to shift the locus of responsibility for personal action from the adolescents themselves to practitioners deserves to be challenged. This is because such shifts of responsibility do not encourage adolescents involved in incidents of this type to learn to control their own behaviour and their inability to do so is the exact reason for their placement in the programme.

Alternative 2: It might be possible for a practitioner to view an incident of this type as being nothing other than “good fun” or simply normal child's play. In such circumstances the practitioner might decide to enter into the activity alongside the adolescents. Indeed why shouldn’t practitioner and adolescents have fun together!

Comment: Intervention of this type which practitioners sometimes justify in terms of their closeness to the adolescents in the programme can be hazardous. This is because the practitioners' involvement confirms for the adolescents that the behaviour is acceptable. This confirmation can then lead to an escalation of the behaviour to new unacceptable levels. If this occurs the practitioners by virtue of sanctioning the earlier behaviour through their involvement in it is likely to find their ability to set appropriate limits seriously compromised. There is also the question as to whether this is desirable given that the practitioner’s task is to teach adult behaviour.

Alternative 3: If intervention is assumed to be necessary then the next question that warrants discussion is whether in this instance, the intervention was timed properly or did it occur too early or too late?

Comment: Certainly it can be argued that in this situation the practitioners involved should have begun to engage with the two adolescents about their water fight plans as soon as they had any information about these plans. The precautionary removal of buckets and hosepipe seems appropriate but more verbal interaction and discussion with the adolescents about the inappropriateness of their planned behaviour around the time of this removal might also have been in order. This might then have enabled the adolescents to modify their actions and thereby reduce the seriousness of the later incident.

It might also be argued that the first intervention that took place, namely forbidding of the use of programme equipment in any water fight and a request for an abandonment of the plan, was both too late and too provocative. By this action the practitioner immediately entered into a power struggle with the two adolescents. Given that acting out adolescents are invariably in conflict with adult authority it is legitimate to suggest that this practice intervention merely enraged the adolescents and helped to escalate the water fight plans into an incident of greater proportion than need have been the case. Certainly following this intervention the issue of control moved rapidly into the centre of the stage. It might also therefore be said that the intervention, rather than assisting the adolescents to give up their plans, had the reverse effect and actually encouraged out of control behaviour. Given that the principal practitioner in this incident was male and the two adolescents female, aspects of power and control may well have been significant.

Alternative 4: Another question that arises is related to the roles of the two practitioners, one female and one male, who were working in the programme at the time of the incident. Given the gender factor, would it have been more profitable for the female practitioner to take a lead in this situation? The male practitioner might then have played the support role.

Comment: This certainly would have provided an alternative intervention that might have been experienced by the female adolescents as less challenging and thereby avoided some of the escalation of events that seems to have occurred.

Alternative 5: Yet another alternative would have been for the two practitioners to work in unison to deal with the emergent incident. This would have involved each practitioner focusing on one of the adolescents and making a point of removing her from the presence of the other. The purpose of this intervention would be to isolate the adolescents from each other and thereby remove peer support for continuation of their water fight plans.

Comment: It can be argued that this type of intervention is the one most likely to lead to a de-escalation of the incident. Certainly separation of the two adolescents allows time for their sense of excitement to subside and their capacity for co-operation with adult practitioners to re-surface. Other alternative responses and influence techniques (Maier, 1987) do exist. Hopefully practitioners reading this article will already have begun to formulate these as they reflect on this analysis.

Developing practice guidelines
Because incidents of the type which have been described and analysed are not uncommon in programmes for troubled children and adolescents it is also worth developing practice guidelines that can shape practitioners' action both before, during and after such events. These guidelines assist in that they help to ensure consistent handling of issues by a team of practitioners. They also help team members feel confident when faced with stressful and demanding situations. Used together with critical incident analysis, but not in place of such efforts, they also help to improve practice responses. Like all guidelines they should be used to refine rather than bureaucratise these responses.

Following the above incident of physical restraint, which was the first of its kind in this programme, the following guideline was drafted.

INCIDENT REPORTING: PHYSICAL RESTRAINT BY PRACTITIONERS OF PROGRAMME RESIDENT(S)

Whilst the physical restraint of adolescents should be avoided, if at all possible, it may be necessary for a practitioner to intervene in this way on occasions. Usually this occurs when an adolescent is either violent or threatening violence towards another programme resident or practitioner. It may also occur when a programme resident is out of control and causing significant disruption to normal programme activities to the point where the behaviour is threatening programme stability.
The intent of any physical restraint must always be the restoration of the individual’s control of his own behaviour. Because of this, any action must use the minimum force necessary to achieve this end and should be designed so that neither party is physically hurt through the intervention.
This restraint is likely to consist of holding or limiting an adolescent’s movements through the use of self to block access to other persons until such time as the individual concerned has regained personal control. It should never include hitting or locking an adolescent in a room or any action likely to cause physical hurt to the adolescent.
If restraint is used it must be recorded immediately in detail in the programme logbook. In addition a full incident report should be written by the person using the restraint for the programme supervisor. This report will be copied to the residential youth services co-ordinator who will discuss the incident with the programme supervisor as soon as possible.
Practitioner(s) who witness such events must also provide a similar report, which should be written independently of that provided by the person who was actually involved in the act of restraint. A copy of this additional report will be copied to the residential youth services co-ordinator. It will be available in time for the above discussion.
All reports should include a full account of events leading up to the intervention. They should include a description of the intervention, the names of all the individuals involved, as well as other programme residents and practitioners who may have witnessed the intervention. The reports should also show how matters were finally resolved and the time frames involved.
These reports will allow the intervention and the circumstances surrounding the intervention to be the subject of detailed analysis. In this way practitioners can improve their skills in regard to a particularly problematic practice area.
These reports also protect practitioners from later claims that they have abused or assaulted a programme resident. An accurate and open recording of incidents involving physical restraint is the best way of dealing with such claims.
Immediately following a situation in which restraint has been used the parent(s) of the adolescent involved should be informed, preferably by the assigned practitioner. This is in line with the programme’s policy in regard to parental involvement. Copies of the reports prepared about the intervention can, if requested, be made available to parents.
The assigned practitioner should also immediately inform any external social work agency with responsibility for the adolescent, of the intervention. Copies of the reports prepared about the intervention can, if requested, be made available to the external agency.

Improving practice skills
Critical incident recording and subsequent analysis is an important means by which practitioners can learn to improve the quality of their practice responses.

The record of this incident of physical restraint clearly illustrates the complexity of the practitioner’s task. It also illustrates that practice in this situation was far from perfect. The imperfection of the responses are in some measure understandable in that incidents develop rapidly and practitioners are required to make decisions almost instantaneously. The incident described covered a fifty minute time period. Subsequent recording and analysis has taken many days. In the author’s view it is through the examination of imperfect practice that practitioners can better prepare themselves for direct work with children and adolescents.

Through detailed examination practitioners may learn to read practice situations quickly and accurately and to be aware of the range of intervention possible. It also helps practitioners think about how different interventions have a different impact on different situations. Finally, it helps practitioners to ensure the selection of appropriate interventions in difficult situations.

Transferring learning
Whilst this article has used an incident of physical restraint as a vehicle for looking at ways in which Child and Youth Care practitioners can improve their practice skills other less emotive incidents can be used for the same purpose. The programme in question has used incidents of adolescents absenting themselves overnight from the programme, and police visits to the programme as worthy of critical analysis out of which have emerged agency-approved practice guidelines. These have undoubtedly improved the consistency and quality of individual and team practice responses. The use of critical incident analysis and the openness it encourages enhances the accountability of practitioners not only to other team members but also to the broader agency responsible for the programme. This accountability is seen as highly desirable as it promotes within the agency a firmer understanding of the complexities and stressful nature of direct practice with troubled children and adolescents.

Bibliography

Beker, J. Critical Incidents in Child Care. Behavioural Publications, New York, 1972.

Bruggen, P. and Pitt-Aikens, T. Authority as a key factor in adolescent disturbance. British Journal of Medical Psychology Vol.42 No.2, 1975.

Maier, H.W. Developmental Group Care of Children and Youth: Concepts and Practice. Haworth Press, New York, 1987.

Minuchin, S. Families and Family Therapy, Tavistock Publications, London, 1974.